Faculty of Public Health, Nursing and Midwifery

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A Secondary Analysis to Determine Variations of Dental Arch Measurements With Age and Gender Among Ugandans
(BMC, 2015) Hilda Okori; Pricilla S. Apolot; Erisa Mwaka; Gerald Tumusiime; William Buwembo; Ian G. Munabi
Background: Dental arch dimensions are useful in dental practice and in forensic odontology. Local data is essential because ethnic differences exist in dental arch dimensions. In the Ugandan population no studies had been done on dental arch dimensions. The objective of the current study was to determine the variations in dental arch dimensions with age and gender in a sample of dental casts from the Ugandan population. Method: This was a secondary analysis of dental casts previously prepared using mandibular and maxillary arch impressions of 220 children (85 boys and 135 girls) aged 12–17 years recruited from schools in Kampala, Uganda. Dental arch dimensions for the maxilla and mandibular casts were taken using a digital vernier calliper. The data was analysed using the means based independent samples t test to obtain the descriptive statistics with regression analy- sis being used to obtain the regression coefficients and constants using STATA 12. Results: The overall maxillary dimensions were significantly smaller in females than males by 1.50 mm (95 % CI −2.91 to −0.09, P = 0.04), controlling for age group. The overall dimensions of the mandible were also smaller in younger participants, though this was not statistically significant. Conclusion: From this study we observed significant differences in arch dimensions between males and females that are of forensic value for this population. There is need for more study of the differences in arch dimensions with age using a larger and more age diverse study population. Keywords: Dental arch, Dimensions, Age, Anatomy, Forensic odontology, Gender
Aetiology and Treatment Outcome of Non-traumatic Small Bowel Perforations at Mbarara Hospital in South-Western Uganda
(BMC, 2012-12) D. Mutiibwa; A. Lopez; G. Tumusiime; D. Riding; A. Diaz
Background: Non-traumatic small bowel perforation (SBP) is the most common form of gastrointestinal perforation in sub-Saharan Africa. Although SBP is a surgical emergency associated with complications, information regarding its aetiology is scanty in Uganda. This study was aimed at determining the aetiology and document treatment outcomes of non-traumatic small bowel perforations in South-western Uganda. Methods: This was a descriptive case series of 87 consenting patients with non-traumatic SBP confirmed atlaparotomy, on the emergency ward of Mbarara University Teaching Hospital. They were enrolled from September 2011 to May 2012. Specimens for blood culture, stool microscopy, HIV testing and tissue biopsies at the site of perforation were collected and analyzed. Patient follow-up was done till discharge. Results: Of the 78 biopsies performed, 66(84.6%) had histological features suggestive of typhoid perforations while 12(15.4%) had features of non-specific inflammation. Salmonella typhi was isolated in 13(15.0%) out of the 87 patients. Isolates were susceptible to Ceftriaxone and Ciprofloxacin. All patients tested HIV negative. Ascaris lumbricoides were seen in two patients. Re-laparotomy was done in four patients with new perforations, two with anastomotic breakdown and two with intra-abdominal abscesses. Wound sepsis was observed in 25(28.7%). Average length of hospital stay was 13 days. Some 10(11.5%) patients died. Conclusions: Most cases of non-traumatic SBP in south western Uganda are associated with Salmonella infection. There is need to enhance laboratory capacity to detect typhoid and preventive measures should be instituted in the general population.
Ileosigmoid Knotting in Pregnancy: A Case Report Seen in Uganda
(COSECSA/ASEA Publication, 2013-12) David Mutiibwa; Gerald Tumusiime
Ileo-sigmoid knotting (ISK) refers to the intertwining of the ileum and the sigmoid colon. The incidence of ISK is not known but generally occurs in areas with high incidence of sigmoid volvulus such as Africa, Asia, Middle East, and South America. ISK is more common in adult males, particularly the old. ISK in pregnancy is not common but if it occurs, early surgical intervention is necessary to avert its associated morbidity and mortality. Normal pregnancy complaints may cloud the clinical picture of ISK and efforts to avoid radiological investigations may contribute to diagnostic delay. We report a case of a pregnant mother in her second trimester who was admitted at Mbarara Regional Referral Hospital with features of intestinal obstruction and exploratory laparotomy revealed ISK with gangrenous bowel. After surgery, she recovered very well, carried her pregnancy to term and delivered normally.
Impact of High Human Genetic Diversity in Africa on Immunogenicity and Efficacy of RTS, S/AS01 Vaccine
(Springer, 2023-04-21) Stephen Tukwasibwe; Isaac Ssewanyana; Gerald Mboowa; Ivan Sserwadda; Joaniter; Nankabirwa; Emmanuel Arinaitwe; Isaac Ssewanyana; Yoweri Taremwa; Gerald Tumusiime; Moses R. Kamya; Prasanna Jagannathan; Annettee Nakimuli
In modern medicine, vaccination is one of the most effective public health strategies to prevent infectious diseases. Indisputably, vaccines have saved millions of lives by reducing the burden of many serious infections such as polio, tuberculosis, measles, pneumonia, and tetanus. Despite the recent recommendation by the World Health Organization (WHO) to roll out RTS,S/AS01, this malaria vaccine still faces major challenges of variability in its efficacy partly due to high genetic variation in humans and malaria parasites. Immune responses to malaria vary between individuals and populations. Human genetic variation in immune system genes is the probable cause for this heterogeneity. In this review, we will focus on human genetic factors that determine variable responses to vaccination and how variation in immune system genes affect the immunogenicity and efficacy of the RTS,S/AS01 vaccine.
Mandatory Anatomy Dissection; Effect on Examination Performance
(Anatomy Africa, 2016-08-01) Mwaka Erisa S; Kukiriza John; Mwesigwa Catherine; Munabi Ian; Buwembo William; Kirum Gonzaga; Kyamanawa Isaac; Okello Micheal; Kiryowa Haruna; Tumusiime Gerald; Masilili Godfrey; Ochieng Joseph; Luboga Samuel; Ibingira Charles
Regular class attendance is evidence of professionalism. This has led to mandatory class attendance in many disciplines including anatomy. However, there is paucity of data on the effect of mandatory class attendance on student performance in resource-limited settings. The objective of this study was to determine the effect of mandatory attendance of anatomy dissections on student’s practical exams. This was an audit of undergraduate first year health professional students performance on the practical summative Steeplechase exam for the anatomy of limbs in two consecutive academic years at Makerere University. The second lot of first year students in the study had all their scheduled anatomy dissection sessions roll called to confirm their attendance that was the intervention arm in the study. The data was analysed with STATA statistical computing software version 13. Some of the tests run on this data included independent samples t test and Regression analysis. The overall performance of students in the academic year varied with roll call and was significantly lower than that in the previous academic year without roll call (mean difference -8.04 95% CI -10.76 to -5.31). Significant reductions in performance were also observed with type of student sponsorship (P<0.01) and the program they were pursuing (P<0.01). Roll calling had the largest effect on student performance demonstrated by the 0.23 standard deviation reduction in performance of students. This study shows that mandatory attendance of anatomy dissections leads to a reduction in the student’s performance on practical anatomy examinations
Morphometry of the Proximal End of Dry Adult Human Femora from the East African Population: A CrossSection Study
(Austin Publishing Group, 2021-08-24) Gerald Tumusiime; Gonzaga Gonza Kirum; John Kukiriza
Introduction: Proximal femur morphometry is important in the stability of the hip joint, the design of implants for hip replacement and forensic identification of unknown human remains. This study aimed at determining the proximal femur morphometry and factors associated with their variation. Materials and Methods: This was a cross-sectional study of the proximal end of 333 dry human femora from persons aged 20 to 75 years from the East African population. All the femora were observed macroscopically for the presence of the third trochanter, and the age, sex and nationality documented. The femoral head and neck circumferences were measured using a tape measure and the neck-shaft angle and the angle of anteversion measured using a goniometer. Data were entered in an Excel sheet and exported to STATA 14 for analysis. Univariate, bivariate and multivariable analyses were performed. A p-value of less than 0.05 was considered statistically significant. Results: Of the 333 dry femora, 7.21% (24/333) had a third trochanter. The mean femoral head circumference was 134.91 ± 8.91 mm, the mean neckshaft angle was 118 ± 6 degrees, the mean angle of anteversion was 17 ± 4 degrees, the mean femoral neck circumference was 91.71 ± 7.40 mm. Statistical significance was achieved between each of the proximal femur measurements and: sex, nationality and third trochanter status. Conclusion: The morphometry of the proximal femur varies with age, sex and nationality. These variations are pertinent in the design of tailored proximal femur implants, assessing the risk of fractures, forensic practice and regional comparisons. Keywords: Immplants; Morphometry; Neck-shaft angle; Proximal femur; Third trochanter
Once-Daily Dolutegravir-Based Antiretroviral Therapy in Infants and Children Living With HIV From Age 4 Weeks: Results From the Below 14 kg Cohort in the Randomised ODYSSEY Trial
(Elsevier, 2022-09) Pauline Amuge; Abbas Lugemwa; Ben Wynne; Hilda A Mujuru; Avy Violari; Cissy M Kityo; Moherndran Archary; Ebrahim Variava; Ellen White; Rebecca M Turner; Clare Shakeshaft; Shabinah Ali; Kusum J Nathoo; Lorna Atwine; Afaaf Liberty; Dickson Bbuye; Elizabeth Kaudha; Rosie Mngqibisa; Modehei Mosala; Vivian Mumbiro; Annet Nanduudu; Rogers Ankunda; Lindiwe Maseko; Adeodata R Kekitiinwa; Carlo Giaquinto; Pablo Rojo; Diana M Gibb; Anna Turkova; Deborah Ford
Background Young children living with HIV have few treatment options. We aimed to assess the efficacy and safety of dolutegravir-based antiretroviral therapy (ART) in children weighing between 3 kg and less than 14 kg. Methods ODYSSEY is an open-label, randomised, non-inferiority trial (10% margin) comparing dolutegravir-based ART with standard of care and comprises two cohorts (children weighing ≥14 kg and <14 kg). Children weighing less than 14 kg starting first-line or second-line ART were enrolled in seven HIV treatment centres in South Africa, Uganda, and Zimbabwe. Randomisation, which was computer generated by the trial statistician, was stratified by first-line or second-line ART and three weight bands. Dispersible 5 mg dolutegravir was dosed according to WHO weight bands. The primary outcome was the Kaplan-Meier estimated proportion of children with virological or clinical failure by 96 weeks, defined as: confirmed viral load of at least 400 copies per mL after week 36; absence of virological suppression by 24 weeks followed by a switch to second-line or third-line ART; all-cause death; or a new or recurrent WHO stage 4 or severe WHO stage 3 event. The primary outcome was assessed by intention to treat in all randomly assigned participants. A primary Bayesian analysis of the difference in the proportion of children meeting the primary outcome between treatment groups incorporated evidence from the higher weight cohort (≥14 kg) in a prior distribution. A frequentist analysis was also done of the lower weight cohort (<14 kg) alone. Safety analyses are presented for all randomly assigned children in this study (<14 kg cohort). ODYSSEY is registered with ClinicalTrials.gov, NCT02259127. Findings Between July 5, 2018, and Aug 26, 2019, 85 children weighing less than 14 kg were randomly assigned toreceive dolutegravir (n=42) or standard of care (n=43; 32 [74%] receiving protease inhibitor-based ART). Median age was 1·4 years (IQR 0·6–2·0) and median weight 8·1 kg (5·4–10·0). 72 (85%) children started first-line ART and 13 (15%) started second-line ART. Median follow-up was 124 weeks (112–137). By 96 weeks, treatment failure occurred in 12 children in the dolutegravir group (Kaplan-Meier estimated proportion 31%) versus 21 (48%) in the standard-of- care group. The Bayesian estimated difference in treatment failure (dolutegravir minus standard of care) was –10% (95% CI –19% to –2%; p=0·020), demonstrating superiority of dolutegravir. The frequentist estimated difference was –18% (–36% to 2%; p=0·057). 15 serious adverse events were reported in 11 (26%) children in the dolutegravir group, including two deaths, and 19 were reported in 11 (26%) children in the standard-of-care group, including four deaths (hazard ratio [HR] 1·08 [95% CI 0·47–2·49]; p=0·86). 36 adverse events of grade 3 or higher were reported in 19 (45%) children in the dolutegravir group, versus 34 events in 21 (49%) children in the standard-of-care group (HR 0·93 [0·50–1·74]; p=0·83). No events were considered related to dolutegravir.
Performance of an Open Source Facial Recognition System for Unique Patient Matching in a Resource-Limited Setting
(International Journal of Medical Informatics, 2020) Kitayimbwa, John M.; Were, Martin C.; Ampamyaa, Sight
Background: The lack of unique patient identifiers is a challenge to patient care in developing countries. Probabilistic and deterministic matching approaches remain sub-optimal. However, affordable and scalable biometric solutions have not been rigorously evaluated in these settings. Methods: We implemented and evaluated performance of an open-source facial recognition system, OpenFace, integrated within a nationally-endorsed electronic health record system in Western Kenya. Patients were first enrolled via facial images, and later matched via the system. Accuracy of facial recognition was evaluated using Sensitivity; False Acceptance Rate (FAR); False Rejection Rate (FRR); Failure to Capture Rate (FTC) and Failure to Enroll Rate (FTE). 103 patients (mean age 37.8, 49.5% female) were enrolled. Results: The system had a sensitivity of 99.0%, FAR<1%, FRR 0.00, FTC 0.00 and FTE 0.00. Wearing spectacles did not affect performance. Conclusion: An open source facial recognition system correctly and accurately identified almost all patients during the first match.
Pervasive and Non-random Recombination in Near Full-Length HIV Genomes From Uganda
(Virus Evolution, 2020) Kitayimbwa, John M.; Grant, Heather E.; Hodcroft, Emma B.; Ssemwanga, Deogratius; Gonzalo, Yebra; Gomez, Luis Roger Esquivel; Frampton, Dan; Gall, Astrid; Kellam, Paul; Oliveira, Tulio de; Bbosa, Nicholas; Nsubuga, Rebecca N.; Kibengo, Freddie; Kwan, Tsz Ho; Lycett, Samantha; Kao, Rowland; Robertson, David L.; Ratmann, Oliver; Fraser, Christophe; Pillay, Deenan; Kaleebu, Pontiano; Brown, Andrew J. Leigh
Recombination is an important feature of HIV evolution, occurring both within and between the major branches of diversity (subtypes). The Ugandan epidemic is primarily composed of two subtypes, A1 and D that have been co-circulating for 50 years frequently recombining in dually infected patients. Here, we investigate the frequency of recombinants in this population and the location of breakpoints along the genome. As part of the PANGEA-HIV consortium, 1,472 consensus genome sequences over 5 kb have been obtained from 1,857 samples collected by the MRC/UVRI & LSHTM Research unit in Uganda, 465 (31.6 per cent) of which were near full-length sequences (>8 kb). Using the subtyping tool SCUEAL, we find that of the near full-length dataset, 233 (50.1 per cent) genomes contained only one subtype, 30.8 per cent A1 (n¼143), 17.6 percent D (n¼82), and 1.7 per cent C (n¼8), while 49.9 per cent (n¼232) contained more than one subtype (including A1/D (n¼164), A1/C (n¼13), C/D (n¼9); A1/C/D (n¼13), and 33 complex types). K-means clustering of the recombinant A1/D genomes revealed a section of envelope (C2gp120-TMgp41) is often inherited intact, whilst a generalized linear model was used to demonstrate significantly fewer breakpoints in the gag–pol and envelope C2-TM regions compared with accessory gene regions. Despite similar recombination patterns in many recombinants, no clearly supported circulating recombinant form (CRF) was found, there was limited evidence of the transmission of breakpoints, and the vast majority (153/164; 93 percent) of the A1/D recombinants appear to be unique recombinant forms. Thus, recombination is pervasive with clear biases in breakpoint location, but CRFs are not a significant feature, characteristic of a complex, and diverse epidemic.
Phylogenetic Networks and Parameters Inferred from HIV Nucleotide Sequences of High-Risk and General Population Groups in Uganda: Implications for Epidemic Control
(Viruses, 2021) Kitayimbwa, John M.; Bbosa, Nicholas; Ssemwanga, Deogratius; Nsubuga, Rebecca N.; Kiwanuka, Noah; Bagaya, Bernard S.; Ssekagiri, Alfred; Gonzalo, Yebra; Kaleebu, Pontiano; Leigh-Brown, Andrew
Phylogenetic inference is useful in characterising HIV transmission networks and assessing where prevention is likely to have the greatest impact. However, estimating parameters that influence the network structure is still scarce, but important in evaluating determinants of HIV spread. We analyzed 2017 HIV pol sequences (728 Lake Victoria fisherfolk communities (FFCs), 592 female sex workers (FSWs) and 697 general population (GP)) to identify transmission networks on Maximum Likelihood (ML) phylogenetic trees and refined them using time-resolved phylogenies. Network generative models were fitted to the observed degree distributions and network parameters, and corrected Akaike Information Criteria and Bayesian Information Criteria values were estimated. 347 (17.2%) HIV sequences were linked on ML trees (maximum genetic distance _4.5%, _95% bootstrap support) and, of these, 303 (86.7%) that consisted of pure A1 (n = 168) and D (n = 135) subtypes were analyzed in BEAST v1.8.4. The majority of networks (at least 40%) were found at a time depth of _5 years. The waring and yule models fitted best networks of FFCs and FSWs respectively while the negative binomial model fitted best networks in the GP. The network structure in the HIV-hyperendemic FFCs is likely to be scale-free and shaped by preferential attachment, in contrast to the GP. The findings support the targeting of interventions for FFCs in a timely manner for effective epidemic control. Interventions ought to be tailored according to the dynamics of the HIV epidemic in the target population and understanding the network structure is critical in ensuring the success of HIV prevention programs.
Surgical Mortality at a Mission Hospital in Western Uganda
(College of Surgeons of East Central and Southern Africa, 2010-08) Gerald Tumusiime
Background: Audit of Surgical mortality seeks to focus on improvement in the process of surgical care and not on individual surgical ability. Audit of surgical mortality was conducted to establish the factors associated with the surgical deaths in Virika Hospital to propose ways of improvement. Methods: The study was conducted in Virika Mission Hospital in Western Uganda, a 155 bed capacity hospital with a surgical bed capacity of 32 located in rural Uganda.Individual case file review of the fourty three surgical deaths from 1st July 2008 to 31st June 2009 was conducted. Additional data was retrieved from hospital admission register, operation registers, and death certificate books. Results: The operation death rate was 1.3%, all were emergencies, and 82.6% were done under general anaesthesia and17.4% died on table. The laparotomy death rate was 12.5%, Herniorrhaphy 0.9%, drainage of pus 1.4% and wound suture 0.4%. Surgery was delayed due to lack of blood in only one case but there was no record of lack of any resource for delaying surgery. Surgical conditions were: Injuries 39.5%, Intestinal perforations 30.2%, Intestinal obstruction 20.9% and others 9.3%. The hospital had no high dependency unit and no intensive care unit. No postmortem was conducted in all cases. Conclusion: Overall the Audit identified client, provider, administrative and community-related factors that need to be addressed collectively to reduce surgical mortality in Virika hospital.Audit of surgical mortality should be part of the health workers’ general approach to making more information available in a meaningful way for continuous improvement of surgical services.
The Number and Determinants of Nutrient Foramina Among Dry Human Femur Bones From the East African Population: A Cross-Section Study
(BMC, 2021) Gerald Tumusiime; Gonzaga Gonza Kirum; John Kukiriza
Background: Nutrient foramina form important landmarks on the femur and other bones as the portal of entry for nutrient arteries. Nutrient arteries are important sources of blood supply for growing bones; and their variations may be due to congenital or acquired causes. These variations are important in anatomical comparisons, orthopaedic surgical practice and forensic medicine. Aims: This study aimed at establishing the number and determinants of the nutrient foramina among dry human femur bones from the East African population. Materials and methods: This was a cross-section study of 333 dry femur bones from the East African population, at the Galloway osteological collection of Makerere University college of health sciences. The number of nutrient foramina on the shaft of each femur, the corresponding demographic, clinical and morphometric characteristics were documented. Data were entered in an Excel sheet and exported to STATA 14 for analysis. Univariate, bivariate and multivariable analyses were performed to obtain the summary statistics and the measures of association. At all levels of analysis, a p-value of less than 0.05 was considered statistically significant. Results: Of the 333 femurs, 291 (87.4%) were from males; and 137(50.15%) were right femurs. The age ranged from 20 to 75 years with a mean age of 35 (SD± 12) years. Nutrient foramina ranged from one to four; mean of 1.4 (SD±0.5) and median of 1 (IQR: 1 to 2). Of the 333 femurs, 199 (59.8%) had one foramen, 129 (38.7%) had two foramina, four femurs had three foramina and one femur had four foramina. There was a statistically significant association between the number of nutrient foramina and the femur’s: mid-shaft circumference (p=0.014; 95%CI: 0.003 to 0.028), nationality (p=0.016; 95%CI: -0.284 to -0.030) and sex (p=0.012; 96% CI: -0.405 to -0.050). Conclusion: Nutrient foramina among femurs from the East African population range from one to four per femur, with predominantly one foramen. The key determinants of the number of foramina are: mean mid-shaft circumference, nationality and sex. These findings are significant in anatomical comparisons; forensic and orthopaedic practices. KEY WORDS: Nutrient foramina, dry human femur, East African population, morphometric characteristics.
The Potential of Solanum Aethopicam Supplementation to Reduce the Anthropometric and Biochemical Risk Factors for Non-communicable Diseases Among Older Persons in Mukono Municipality, Uganda: A Before-and-After Study
(BMC, 2023-10-06) Gerald Tumusiime; Elizabeth Kizito Balyejusa; Anthony Kkonde; Mildred Julian Nakanwagi; Stephen Tukwasibwe; Catherine Ndagire; Martin Mutambuka
Background: Non-communicable diseases contribute to over 70% of all deaths globally with the majority of the deaths in low and middle-income countries. Although increased vegetable consumption is a cost-effective intervention to mitigate the burden of non-communicable diseases, little is known about African indigenous vegetables to guide their consumption, especially among older persons. This study, aimed at exploring the potential of dietary Solanum aethopicam Shum supplementation in the reduction of the risk of non-communicable diseases among older persons aged 50 years and above in Mukono municipality,Uganda. Methods: This was a before-and-after study of 100 community-dwelling older persons aged 50 years and above residing in cosmopolitan Mukono Municipality in central Uganda. The meal of each participant was supplemented with 375g of Solanum aethiopicum Shum per day for four weeks. Anthropometric and biochemical parameters were collected at baseline and at the end of the four weeks. All measurements were taken in the morning after an overnight fast. Data was entered into an Excel sheet and transferred to STATA software for analysis. All data was summarized in tables and texts. Results: Of the 100 older persons aged 50 to 88 years (mean 63 ± 10), 60% were females and on average, males were older than females. Based on the body mass index, five percent were underweight, 40% were normal, and 55% were overweight or obese at baseline. After supplementation with Solanum aethiopicum Shum, three percent were normal, 44% were normal and 53% were overweight or obese. Also, there was a mean reduction in the participants’ weight, body mass index, mid-upper arm circumference, abdominal girth, hip circumference, and C-reactive protein. Conclusion: The results suggest that supplementation of the older persons’ diet with Solanum aethiopicum Shum improves their nutrition status, and leads to a reduction in the mean weight, body mass index, mid-upper arm circumference, abdominal girth, hip circumference, and C-reactive protein levels. Dietary supplementation with Solanum aethiopicum Shum should be promoted as a potential strategy to reduce the risk of non-communicable diseases among older persons.

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